腹腔镜下冷循环微波消融联合肝切除治疗肝血管瘤的临床研究

摘要

目的 探讨腹腔镜下冷循环微波消融联合肝切除治疗肝血管瘤的可行性及临床疗效.方法 回顾性分析2015年3月-2017年10月武汉市江夏区第一人民医院收治的13例肝血管瘤行腹腔镜下冷循环微波消融联合肝切除治疗的病例资料,其中男性5例,女性8例;平均年龄52岁,年龄范围为45～68岁;病程18个月至8年,平均4.2年.分析其临床资料并记录手术时间、术中失血量、术后住院时间、肝功能变化及并发症发生情况.采用SPSS 17.0统计软件对数据进行统计分析,正态分布的计量资料以均数±标准差(Mean±SD)表示.结果 13例手术均获得成功,其中处理单发肝血管瘤7例(病灶位于肝Ⅱ、Ⅲ、Ⅳ段),处理多发肝血管瘤6例(病灶位于肝Ⅱ、Ⅲ、Ⅳ、Ⅶ、Ⅷ段),术中均未实施肝门阻断,手术时间为(135.4±35.8) min,术中失血量为(95.2±22.7) ml,术后住院时间为(6.4±0.8)d.术后第1天谷丙转氨酶(354.2±75.4) IU/L,谷草转氨酶(382.7 ±68.5) IU/L,术后1周内均降至正常范围.术后无胆漏、出血、肾功能衰竭等严重并发症发生,术后门诊随访6～12个月无复发.结论 在严格控制手术指征的前提下,腹腔镜下冷循环微波消融联合肝切除治疗肝血管瘤安全可行,能同时处理多个病灶,且冷循环微波消融能有效减少术中出血,具有微创效果.%Objective To explore the clinical effect and feasibility of cold cycle microwave ablation combined with laparoscopic hepatectomy for hepatic hemangioma.Methods Thirteen cases of hepatic hemangiomas were treated with cold cycle microwave ablation combined with laparoscopic hepatictomy,and their clinical data were analyzed retrospectively from March 2015 to October 2017 in the First People's Hospital of Jiangxia District of Wuhan City,including 5 males and 8 females with an average age of 52 years and age range of 45-68 years.The course of disease was 18 months to 8 years,with an average of 4.2 years.The clinical data were retrospectively analyzed and the operation time,intraoperative blood loss,postoperative hospital stay,liver function changes and complications were recorded.The data were analyzed using SPSS 17.0 statistical software,and measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD).Results The operations of the 13 cases were successful,including 7 cases of single hepatic hemangioma (the lesions were located in segments 11,111 and Ⅳ) and 6 cases of multiple hepatic hemangioma (the lesions were located in segments Ⅱ,Ⅲ,Ⅳ,Ⅶ and Ⅷ).No hepatic portal occlusion was performed during the operation.The operation time was (135.4 ± 35.8) min,intraoperative blood loss was (95.2 ± 22.7) ml,the postoperative hospital stay was (6.4 ± 0.8) d.On the first postoperative day,alanine aminotransferase was (354.2 ± 75.4) IU/L,and aspartate aminotransferase was (382.7 ± 68.5) IU/L,during the first week after surgery,alanine aminotransferase and aspartate aminotransferase both decreased to the normal range,and no serious complications such as bile leakage or hemorrhage occurred after surgery.No recurrence was observed after 6 to 12 months of follow-up.Conclusions Under the premise of strict control of surgical indications,laparoscopic cold-circulation microwave ablation combined with hepatectomy for hepatic hemangioma is safe and feasible.It can simultaneously treat multiple lesions,and cold-cycle microwave ablation can effectively reduce intraoperative bleeding with a minimally invasive effect.